Cuidado transcultural em maternidades a puérperas e neonatos expostos a substâncias psicoativas no pré-natal / Cross-Cultural Care In Maternities To Puerpera And Newborns Exposed To Psychoactive Substances In Prenatal

O abuso de substâncias psicoativas pela mulher no período pré-natal tem chamado a atenção para a necessidade de práticas de cuidado materno-neonatal que sejam culturalmente competentes. Desta forma, este estudo teve como objetivo relatar limitações e potencialidades de cuidado transcultural ao binômio mãe usuária de álcool ou outras drogas e seu neonato, observadas no dia a dia da maternidade. Trata-se de uma pesquisa qualitativa de natureza exploratória, descritiva, com perspectiva etnográfica sobre o cuidado prestado ao binômio mãe usuária de álcool ou outras drogas e seu neonato, realizada entre 2018 e 2020 em maternidades. Os dados foram obtidos por meio de observação participante e entrevistas às puérperas e profissionais de saúde, discutindo-os à luz da Teoria de Madeleine Leininger. As limitações e potencialidades do cuidado focaram no acolhimento, na comunicação entre os profissionais e as pacientes, na identificação de sinais de dependência e abstinência na puérpera, nas orientações em saúde e na rotina de avaliação neonatal. A compreensão cultural e o vínculo etnográfico permitiram uma relação de confiança, de busca de conhecimento e de construção coletiva para o efetivo cuidado culturalmente congruente frente às limitações encontradas.

The abuse of psychoactive substances by women during the prenatal period has called attention to the need for culturally competent maternal-neonatal care practices. Thus, this study aimedto report limitations and potentialities of cross-cultural care to the binomial mother who uses alcohol or other drugs and her newborn, observed in the daily life of the maternity ward. It is qualitative research of exploratory, descriptive nature, with ethnographic perspective on the care provided to the binomial mother who uses alcohol or other drugs and her newborn, conducted between 2019 to 2020 in maternity hospitals. The data were obtained through participant observation and interviews to puerperae and health professionals, discussing them in the light of Madeleine Leininger's Theory. The limitations and potentialities of care focused on the reception, communication between professionals and patients, identification of signs of dependence and abstinence in puerperae, health guidelines, and routine neonatal evaluation. The cultural understanding and the ethnographic bond allowed a relationship of trust, search for knowledge, and collective construction for the effective culturally congruent care in face of the limitations found.

Impacto da doença crónica pediátrica na qualidade de vida dos pais e satisfação com os cuidados de saúde / Impact of pediatric chronic disease on the parent's quality of life and healthcare satisfaction

A qualidade de vida relativa à saúde surge como uma medida de resultado de saúde para compreender o impacto da doença e do tratamento no funcionamento familiar, consistindo também num importante indicador de adaptação da família à doença crónica. Decisões quanto à implementação de medidas de melhorias na saúde e na eficácia das intervenções desenvolvidas no apoio às famílias podem ser adotadas com base na avaliação da qualidade de vida. Dada a sua crescente relevância na prestação de cuidados de saúde junto das famílias, foram definidos como objetivos do estudo: avaliar o impacto das condições de saúde crónicas pediátricas na qualidade de vida dos pais e da família, avaliar a satisfação dos mesmos com os cuidados de saúde prestados e analisar a relação entre o impacto das condições de saúde crónicas pediátricas na qualidade de vida dos pais e na sua satisfação com os cuidados de saúde. Desenvolveu-se um estudo transversal, descritivo e correlacional. Os instrumentos de colheita de dados foram as escalas PedsQL™ Módulo de Impacto na Família e PedsQL™ Módulo Genérico da Satisfação com os Cuidados de Saúde. O questionário foi administrado a 135 pais de crianças/adolescentes portadores de doença crónica e/ou perturbação, em três instituições hospitalares da região norte de Portugal. Os resultados sugerem que os pais percecionam a sua qualidade de vida e funcionamento familiar como moderadas e uma elevada satisfação com os cuidados de saúde. Foi ainda observada uma correlação moderada positiva significativa entre o score total da escala da qualidade de vida dos pais e funcionamento familiar e o score total da escala da satisfação com os cuidados de saúde (r=0,43; p=0,001). Os resultados sugerem que as intervenções de enfermagem promotoras da qualidade de vida dos pais, reduzem o impacto negativo da doença crónica na família, promovendo também uma experiência mais satisfatória com os cuidados de saúde prestados.

Health-related quality of life emerges as a health outcome measure to understand the impact of disease and treatment on family functioning, it is also an important indicator of the family's adaptation to chronic illness. Decisions regarding the implementation of measures to improve health and the effectiveness of interventions developed to support families can be taken based on the assessment of quality of life. Given its growing relevance in providing healthcare to families, the objectives of the study were: assess the impact of pediatric chronic health conditions on the parents and family's quality of life, assess their healthcare satisfaction and analyze the relationship between the impact of pediatric chronic health conditions on the parents and on the family's quality of life and healthcare satisfaction. A cross-sectional, descriptive and correlational study was developed. To measure the impact of pediatric chronic health conditions on parents and the family was used the PedsQL™ Family Impact Module and for measure the healthcare satisfaction we used the PedsQL™ Healthcare Satisfaction Generic Module. The questionnaire was administered to 135 parents of children and adolescents with chronic illness and/or disorder, in three hospitals in the northern region of Portugal. The results suggest that parents perceive their quality of life and family functioning as moderate and a higher healthcare satisfaction. A significant moderate positive correlation was also observed between the parent self-reported functioning and family functioning on the total score and the healthcare satisfaction total score (r=0,43; p=0,001). The results suggest that nursing interventions that promote quality of life for parents reduce the negative impacto f chronic illness on the family, also promoting a more satisfactory experience with the healthcare provided.

Diagnósticos e intervenções de enfermagem a crianças com sinais respiratórios de gravidade da covid-19 / Diagnósticos e intervenciones de enfermería para niños con signos respiratorios de gravedad covid-19 / Nursing diagnoses and interventions for children with respiratory signs of covid-19 severity

Objetivo descrever diagnósticos e intervenções de enfermagem a crianças com sinais respiratórios de gravidade da COVID-19. Método estudo exploratório, descritivo, do tipo revisão narrativa, realizado em junho de 2020, embasado pelas evidências científicas publicadas na base PUBCOVID-19, para posterior elaboração de diagnósticos utilizando a Taxonomia North American Nursing Diagnoses Association - International, e intervenções ancoradas na Nursing Interventions Classification. Resultados a dispneia e o desconforto respiratório foram os sinais de gravidade mais evidenciados na criança com COVID-19. Foram elaboradas três principais afirmativas diagnósticas: Troca de Gases Prejudicada, Padrão Respiratório Ineficaz e Ventilação Espontânea Prejudicada, com 24 Intervenções de Enfermagem correspondentes em quatro domínios: o fisiológico, comportamental, de segurança, e o de família. Conclusão a descrição dos diagnósticos e intervenções de enfermagem, ancorados pelas taxonomias NANDA e NIC, respectivamente, apresenta inovação na literatura científica brasileira.

Objetivo describir diagnósticos e intervenciones de enfermería a niños con signos respiratorios de gravedad COVID-19. Método estudio exploratorio, descriptivo, de revisión narrativa, realizado en junio de 2020, basado en evidencia científica publicada en la base de datos PUBCOVID-19, para la preparación ulterior de diagnósticos utilizando la Taxonomía North American Nursing Diagnosis Association - International, e intervenciones ancladas en la Clasificación de Intervenciones de Enfermería. Resultados la disnea y la dificultad respiratoria fueron los signos más evidentes de gravedad en niños con COVID-19. Se elaboraron tres declaraciones diagnósticas principales: Deterioro de Intercambio de Gases, Patrón Respiratorio Ineficaz y Deterioro de Ventilación Espontánea, con 24 Intervenciones de Enfermería correspondientes en cuatro ámbitos: fisiológica, conductual, seguridad y familia. Conclusión la descripción de los diagnósticos e intervenciones de enfermería, anclados por taxonomías NANDA y NIC, respectivamente, presenta innovación en la literatura científica brasileña.

Objective to describe nursing diagnoses and interventions to children with respiratory signs of COVID-19 severity. Method exploratory, descriptive, narrative review study, conducted in June 2020, based on scientific evidence published in the PUBCOVID-19 database, for further preparation of diagnoses using the North American Nursing Diagnoses Association - International Taxonomy, and interventions anchored in the Nursing Interventions Classification. Results dyspnea and respiratory distress were the most evident signs of severity in children with COVID-19. Three main diagnostic statements were elaborated: Impaired Gas Exchange, Ineffective Respiratory Pattern and Impaired Spontaneous Ventilation, with 24 Nursing Interventions corresponding in four domains: physiological, behavioral, safety, and family. Conclusion the description of nursing diagnoses and interventions, anchored by NANDA and NIC taxonomies, respectively, presents innovation in the Brazilian scientific literature.

Extracellular matrix-based biomaterials as adipose-derived stem cell delivery vehicles in wound healing: a comparative study between a collagen scaffold and two xenografts.

BACKGROUND: Stem cell therapies represent a promising tool in regenerative medicine. Considering the drawbacks of direct stem cell injections (e.g. poor cell localisation), extracellular matrix-based biomaterials (e.g. scaffolds and tissue grafts), due to their compositional biofunctionality and cytocompatibility, are under investigation as potential stem cell carriers. METHODS: The present study assessed the potential of three commercially available extracellular matrix-based biomaterials [a collagen/glycosaminoglycan scaffold (Integra™ Matrix Wound Dressing), a decellularised porcine peritoneum (XenoMEM™) and a porcine urinary bladder (MatriStem™)] as human adipose-derived stem cell delivery vehicles. RESULTS: Both tissue grafts induced significantly (p < 0.01) higher human adipose-derived stem cell proliferation in vitro over the collagen scaffold, especially when the cells were seeded on the basement membrane side. Human adipose-derived stem cell phenotype and trilineage differentiation potential was preserved in all biomaterials. In a splinted wound healing nude mouse model, in comparison to sham, biomaterials alone and cells alone groups, all biomaterials seeded with human adipose-derived stem cells showed a moderate improvement of wound closure, a significantly (p < 0.05) lower wound gap and scar index and a significantly (p < 0.05) higher proportion of mature collagen deposition and angiogenesis (the highest, p < 0.01, was observed for the cell loaded at the basement membrane XenoMEM™ group). All cell-loaded biomaterial groups retained more cells at the implantation side than the direct injection group, even though they were loaded with half of the cells than the cell injection group. CONCLUSIONS: This study further advocates the use of extracellular matrix-based biomaterials (in particular porcine peritoneum) as human adipose-derived stem cell delivery vehicles. Comparative analysis of a collagen scaffold (Integra™ Matrix Wound Dressing) and two tissue grafts [decellularised porcine peritoneum (XenoMEM™) and porcine urinary bladder (MatriStem™)] as human adipose-derived stem cells carriers.

Feasibility and safety of high-intensity interval training for the rehabilitation of geriatric inpatients (HIITERGY) a pilot randomized study.

BACKGROUND: High-intensity interval training (HIIT) has been shown to be more effective than moderate-intensity continuous training (MICT) for the physical rehabilitation. However, data on its suitability for older hospitalized patients is scarce. METHODS: Randomized controlled trial in a hospital setting. Inclusion of 100 patients, ≥65 years old, hospitalized for rehabilitation after an acute medical condition, in a two-week rehabilitation program of either four HIIT or three MICT sessions per week. Completion was defined as participation in all but two planned sessions accomplishing ≥50% of each session. We assessed: upper-limb muscle strength (handgrip isometric strength test), lower-limb muscle strength (quadriceps and ankle flexion and extension tests); gait speed and spatio-temporal parameters (instrumented walkway), and exercise capacity (6-min walk test). All adverse events were recorded as safety endpoints. RESULTS: An intention-to-treat analysis showed a 44% completion rate for the HIIT group (95% CI, 30-59) and 77% for MICT (95% CI, 55-82). A modified intention-to-treat analysis restricted to patients who participated in ≥1 session showed an 88% completion rate in the HIIT group (95%CI, 69-97) and an 80% completion rate in MICT (95%CI, 65-90). The exercises most frequently undertaken were the pedal exerciser (54%) and the NuStep (32%). There were no significant differences in the various measures. No serious adverse events occurred. CONCLUSION: A HIIT rehabilitation program for this population was feasible, safe and had a high adherence rate. TRIAL REGISTRATION NUMBER: Clinicatrials.gov ID: NCT02318459. Trial registration date: November 7th, 2014. Retrospectively registered. This study adheres to the CONSORT guidelines.

[Bouveret's Syndrome: A Case Report and a Brief Literature Review]. / Síndrome de Bouveret: Apresentação de Um Caso Clínico e Breve Revisão da Literatura.

Bouveret's syndrome is a rare cause of gastric outlet obstruction. We report a case of a 68-year-old woman admitted with upper digestive obstruction. A few months later, and after several diagnostic tests and clinical surveillance, a cholecystoduodenal fistula was suspected. During exploratory laparotomy, the diagnosis of Bouveret's syndrome was confirmed and a pyelolithotomy, pyloroplasty and a cholecystectomy were performed. The patient was asymptomatic 7 months after the operation. This syndrome represents only 1% - 3% of all cases of gallstone ileus, being more frequent in women and in the elderly. The presentation is quite nonspecific, but in most cases the symptomatology suggests an upper digestive occlusion. Treatment can be achieved by lithotripsy, but most patients require a surgical approach.

Apesar de rara, a síndrome de Bouveret é uma das causas descritas de obstrução ao esvaziamento gástrico. Apresentamos o caso clínico de uma doente do género feminino com 68 anos, admitida por quadro sugestivo de 'obstrução digestiva alta'. Após avaliação clínica e realização de estudo complementar, viria a ser colocada, alguns meses mais tarde, a suspeita de fístula colecistoduodenal. A doente foi submetida a laparotomia exploradora, que confirmou o diagnóstico de síndrome de Bouveret, com realização de pilorolitotomia, piloroplastia e colecistectomia. Aos sete meses, encontrava-se assintomática. Esta síndrome representa apenas 1% - 3% de todos os íleos biliares, sendo mais frequente em mulheres e indivíduos mais idosos. A forma de apresentação é bastante inespecífica, mas na maioria dos casos a sintomatologia sugere um quadro de oclusão digestiva alta. O tratamento pode ser realizado através de litotrícia, mas na grande maioria dos doentes é necessária uma abordagem cirúrgica do problema.

Beta-Blockers and Cancer: Where Are We?

Cancer is one of the leading causes of death worldwide. After diagnosis, cancer treatment may involve radiotherapy, chemotherapy, and surgery. Several of the approaches used to treat cancer also attack normal cells and, thus, there is the need for more effective treatments that decrease the toxicity to normal cells and increase the success rates of treatment. The use of beta-blockers in cancer has been studied for their antagonist action on the adrenergic system through inhibition of beta-adrenergic receptors. Besides regulating processes such as blood pressure, heart rate, and airway strength or reactivity, beta-blockers block mechanisms that trigger tumorigenesis, angiogenesis, and tumor metastasis. This study presents a literature review of the available studies addressing cancer treatments and beta-blockers. Overall, data suggest that propranolol may be used as a complement for the treatment of several types of cancer due to its ability to improve cancer outcomes by decreasing cancer cell proliferation rates. Nonetheless, additional in vitro studies should be performed to fully understand the protective role of BBs in cancer patients.

Síndrome de Burnout em profissionais de enfermagem* / Burnout Syndrome in nursing professionals

Objetivo: identificar a prevalência da Síndrome de Burnout em profissionais de Enfermagem de um hospital de emergência. Método: trata-se de um estudo quantitativo, descritivo, transversal, fundamentado pela Teoria dos Sistemas de Neuman, com 106 profissionais de enfermagem. Utilizaram-se como instrumentos de coleta de dados um questionário sociodemográfico e o Maslach Burnout Inventory. Utilizaram-se, para armazenamento das informações, a planilha Excel® e, para análise descritiva, o programa Bioestatistic. Adotou-se nível de significância estatística <0,05 e realizou-se teste de correlação linear. Resultados: revelou-se a prevalência de pontuação média nas três dimensões da Síndrome de Burnout; Exaustão Emocional; Despersonalização e Realização Profissional. Conclusão: conclui-se que houve predominância do nível moderado nas três dimensões do Burnout, resultado que se mostra preocupante, uma vez que, como defendido por Betty Neuman em sua teoria, a estabilidade do sistema e a necessidade deste ser mantido em equilíbrio são essenciais para evitar o adoecimento psíquico, inclusive, no ambiente laboral.(AU)

Objective: to identify the prevalence of Burnout Syndrome in nursing professionals of an emergency hospital. Method: this is a quantitative, descriptive, cross-sectional study, based on the Neuman Systems Theory, with 106 nursing professionals. The data collection instruments used were a sociodemographic questionnaire and the Maslach Burnout Inventory. For information storage, the Excel® spreadsheet was used and, for descriptive analysis, the Bioestatistic program. Statistical significance level <0.05 was adopted and linear correlation test was performed. Results: the prevalence of average score in the three dimensions of Burnout Syndrome was revealed; Emotional Exhaustion; Depersonalization and Professional Achievement. Conclusion: it is concluded that there was a predominance of moderate level in the three dimensions of Burnout, a result that is worrying, since, as defended by Betty Neuman in his theory, the stability of the system and the need for it to be kept in balance are essential to avoid mental illness, including in the workplace.(AU)

Objetivo: identificar la prevalencia del Síndrome de Burnout en profesionales de Enfermería de un hospital de urgencias. Método: este es un estudio cuantitativo, descriptivo, transversal, basado en la teoría de Sistemas de Neuman, con 106 profesionales de enfermería. Los instrumentos de recolección de datos utilizados fueron un cuestionario sociodemográfico y el Maslach Burnout Inventory. Para el almacenamiento de informaciones, se utilizó la hoja de cálculo Excel® y, para el análisis descriptivo, el programa Bioestatistic. Se adoptó un nivel de significación estadística <0,05 y se realizó una prueba de correlación lineal. Resultados: se reveló la prevalencia del puntaje promedio en las tres dimensiones del Síndrome de Burnout; Agotamiento Emocional; Despersonalización y Logro Profesional. Conclusión: se concluye que hubo un predominio de nivel moderado en las tres dimensiones de Burnout, un resultado que es preocupante, ya que, como defiende Betty Neuman en su teoría, la estabilidad del sistema y la necesidad de mantenerlo en equilibrio son esenciales para evitar enfermedades mentales, incluso en el lugar de trabajo.(AU)

Local pharmacological induction of angiogenesis: Drugs for cells and cells as drugs.

The past decades have seen significant advances in pro-angiogenic strategies based on delivery of molecules and cells for conditions such as coronary artery disease, critical limb ischemia and stroke. Currently, three major strategies are evolving. Firstly, various pharmacological agents (growth factors, interleukins, small molecules, DNA/RNA) are locally applied at the ischemic region. Secondly, preparations of living cells with considerable bandwidth of tissue origin, differentiation state and preconditioning are delivered locally, rarely systemically. Thirdly, based on the notion, that cellular effects can be attributed mostly to factors secreted in situ, the cellular secretome (conditioned media, exosomes) has come into the spotlight. We review these three strategies to achieve (neo)angiogenesis in ischemic tissue with focus on the angiogenic mechanisms they tackle, such as transcription cascades, specific signalling steps and cellular gases. We also include cancer-therapy relevant lymphangiogenesis, and shall seek to explain why there are often conflicting data between in vitro and in vivo. The lion's share of data encompassing all three approaches comes from experimental animal work and we shall highlight common technical obstacles in the delivery of therapeutic molecules, cells, and secretome. This plethora of preclinical data contrasts with a dearth of clinical studies. A lack of adequate delivery vehicles and standardised assessment of clinical outcomes might play a role here, as well as regulatory, IP, and manufacturing constraints of candidate compounds; in addition, completed clinical trials have yet to reveal a successful and efficacious strategy. As the biology of angiogenesis is understood well enough for clinical purposes, it will be a matter of time to achieve success for well-stratified patients, and most probably with a combination of compounds.

O processo de enfermagem na atenção básica em um município de Alagoas, Brasil / The nursing process in the primary attention of a municipality of Alagoas, Brazil / El proceso de enfermería en la atención primaria de un municipio de Alagoas, Brasil

Objetivo: Analisar a aplicação do Processo de Enfermagem por enfermeiros que atuam na atenção básica de um município do agreste alagoano. Método: Trata-se de um estudo descritivo de abordagem qualitativa, com base na Análise de Conteúdo de Bardin. Foram entrevistados 14 enfermeiros e os dados qualitativos foram agrupados pela tendência de conteúdos. Resultado: As respostas agrupadas e organizadas originaram duas categorias: (1) O uso da SAE pelo enfermeiro na Atenção Básica em Saúde: potencialidades e limitações; (2) Aplicação das etapas do Processo de Enfermagem: parcialidade e desconhecimento. Conclusão: Os resultados revelaram a parcialidade na aplicação do Processo de Enfermagem no dia a dia do enfermeiro e a necessidade de empoderamento do enfermeiro quanto à sua identidade e prática profissional (AU).

Objective: To analyze the application of the Nursing Process by nurses who work in the basic care of a municipality in the rural area of Alagoas. Methods: This is a qualitative descriptive study, based on the Bardin Content Analysis. Fourteen nurses were interviewed and the qualitative data were grouped by the content trend. Results: The grouped and organized responses gave rise to two categories: (1) The use of SAE by the nurse in Primary Health Care: potentialities and limitations; (2) Application of the stages of the Nursing Process: bias and lack of knowledge. Conclusions: The results revealed the bias in the application of the Nursing Process in the daily routine of nurses and the need for nurses' empowerment regarding their professional identity and practice (AU).

Objetivo: Analizar la aplicación del Proceso de Enfermería por enfermeros que actúan en la atención básica de un municipio del agreste alagoano. Métodos: Se trata de un estudio descriptivo de enfoque cualitativo, basado en el análisis de contenido de Bardin. Se entrevistaron a 14 enfermeros y los datos cualitativos fueron agrupados por la tendencia de contenidos. Resultados: La respuesta se originaron agruparon y ensamblaron dos categorías: (1) El uso de SAE por enfermeras en Primaria de la Salud: potencial y limitaciones; (2) Aplicación de las etapas del proceso de enfermería: parcialidad y desconocimiento. Conclusiones: Los resultados revelaron la parcialidad en la aplicación del Proceso de Enfermería en el día a día del enfermero y la necesidad de empoderamiento del enfermero en cuanto a su identidad y práctica profesional (AU).

Primary thyroid lymphoma: A case report and review of the literature.

INTRODUCTION: A rapidly enlarging mass of the anterior compartment of the neck with compressive symptoms may represent, among other diagnosis, a neoplasm of the thyroid gland. PRESENTATION OF CASE: We describe the case of a 59-year-old woman referred to the endocrine surgical unit because of compressive cervical symptoms for 3 months. The cervical ultrasound revealed a sub-sternal goiter with heterogeneous echo structure and the fine-needle aspirating cytology was inconclusive. Given the large impact of symptoms on life quality, she was submitted to a total thyroidectomy. Histological examination of the surgical specimen revealed the presence of a Diffuse Large B Cell Lymphoma of the thyroid. DISCUSSION: Primary thyroid lymphomas are rare and there are few randomized studies for diagnostic and therapeutic guidance. New immunohistochemical and molecular techniques have improved the diagnostic accuracy with corebiopsy limiting the role of surgery. The treatment should first include the control of local disease with radiotherapy and/or surgery combined with chemotherapy to control obscure or disseminated disease. Palliative surgery may be needed to relieve airway compression symptoms. Under these circumstances, surgery should be performed by a specialized surgeon to decrease the associated morbidity. The prognosis of patients depends on the histological classification of the tumor and the stage of the disease. CONCLUSION: Due to the rarity of the disease, each case must be evaluated and treated individually, since there is not a consensual therapeutic approach.